Why is my insurer demanding an independent medical exam?

One of the most common questions we get is about independent medical examinations. You are limping along (perhaps literally) on disability, and out of the blue the insurance company wants proof that you are still disabled.

This is disheartening and scary. An unfavorable exam could cancel your benefits or force you to go back to work while you are ailing. Why is the insurer asking for an IME? Are you required to go?

 

 

The dreaded IME: Yes, you should be concerned

Most long-term disability insurance (LTD) policies contain a provision for independent medical exams (IME). Upon request, the insurance company can send you to an IME, during the initial application for disability or at any time while you are receiving disability benefits.

In theory, the purpose of the IME is to investigate your claim or to verify that your condition is still disabling. In reality, insurance companies use IME’s to undermine your claim to justify denial, reduction or termination of your benefits.

  • They don’t need a reason – There is no “probable cause” requirement. Insurers can send you to an IME at any time.

  • They are not interested in confirming disability – The insurance company is fishing for any reason to reject your claim or terminate your LTD benefits. The exam itself may be very cursory. The doctor’s questions are likely geared to downplaying your condition.

  • It’s not independent – In most cases, the “independent” physician who is performing the exam has been hand-picked by the insurance company. In theory, this is to assure that the doctor is qualified to assess your impairment and testify to their professional opinion. In reality, IME physicians consistently side with the insurers and conclude that the patient is not disabled or is no longer disabled.

  • Yes, you must submit to an IME – The policies and the law are quite clear. If the insurer schedules an IME, you must go. Failure to submit to the exam can result in cancellation of your claim or termination of benefits. But you do have certain rights, including a detailed explanation for any denial or change in benefits. You also have the right to a medical second opinion if you disagree with the IME report.

We deal with this bias all the time

For example, Pillsbury & Coleman represented former NFL football player Charles Dimry, who filed for disability stemming from injuries suffered in his playing days. At trial, we prevailed in showing that the league’s IME doctor arbitrarily concluded that Mr. Dimry was not disabled, despite substantial medical evidence to the contrary. The court took the NFL to task for abuse of discretion in denying his long-term disability claim, which was essentially a finding of bad faith. He was awarded attorney fees and the league’s disability plan was ordered to re-examine the claim … with the expectation that an honest review of his case would result in an award of (retroactive) disability benefits.

That high-profile case is just one in a long line of similar denials. The independent medical exam is regularly weaponized by disability insurers to limit their payout of benefits. Our attorneys regularly fight insurance companies when they take advantage of disability claimants at their most vulnerable point.

No Comments

Leave a comment
Comment Information
Email Our Attorneys

Our Insurance Lawyers Can Help

Bold labels are required.

Contact Information
disclaimer.

The use of the Internet or this form for communication with the firm or any individual member of the firm does not establish an attorney-client relationship. Confidential or time-sensitive information should not be sent through this form.

close

Privacy Policy

  • American Board of Trial Advocates
    American Board of Trial Advocates A prestigious national association of experienced trial lawyers and judges. Membership is by exclusive invitation only. All members shall have completed 10 civil jury trials to jury verdict or hung jury as lead counsel.
  • Best Lawyers
    Best Lawyers The oldest and most respected peer-review publication in the legal profession. A listing in Best Lawyers is widely regarded by both clients and legal professionals as a significant honor, conferred on a lawyer by his or her peers.
  • AV | PeerReviewRated | Martindale-Hubbell | For Ethical Standards and Legal Ability
    Martindale-Hubbell Peer Review Ratings An objective peer review rating indicator of a lawyer's high ethical standards and professional ability, generated from evaluations of lawyers by other members of the bar and the judiciary. Pillsbury & Coleman founding partner Philip L. Pillsbury Jr. is rated “AV Preeminent.”
  • Super Lawyers
    Super Lawyers A peer-review rating service of outstanding lawyers from more than 70 practice areas who have attained a high-degree of peer recognition and professional achievement.
  • Best Lawyers | Best Law Firms | U.S.News & World Report | 2019
    Best Lawyers Best Law Firms U.S. News 2019
  • American Association for Justice | Formerly the Association of Trial Lawyers of America (ATLA)
    American Association for Justice (AAJ) Founded in 1946, AAJ is the world’s largest trial bar and supports the work of attorneys to ensure that injured plaintiffs can obtain justice.
  • American College of Coverage Counsel
    American College of Coverage and Extracontractual Counsel Composed of preeminent insurance coverage counsel in the United States and Canada, representing the interests of both insurers and policyholders. The minimum membership requirement is the practice of insurance law for at least fifteen consecutive years.
  • Association of Business Trial Lawyers | abtl
    Association of Business Trial Lawyers Founded in 1972, ABTL is dedicated to connecting litigators and judges to address issues important to trial lawyers.
  • Consumer Attorneys of California
    Consumer Attorneys of California The only California-wide unified trial bar for plaintiffs lawyers who represent consumers harmed by powerful foes such as insurance companies, pharmaceutical companies, automobile manufacturers and banks.
  • SFTLA | San Francisco Trial Lawyers Association
    San Francisco Trial Lawyers Association For over 60 years, this prestigious bar association has educated and trained trial lawyers and supported and passed critical legislation to protect and advance individuals’ rights.
  • United Policyholders | Empowering the Insured
    United Policyholders A non-profit group dedicated to providing trustworthy and useful information and an effective voice for insurance consumers in all 50 states.
  • America's Top 100 High Stakes Litigators | 2018 | Top 100
    ACCEC | American College of Coverage and Extracontractual Counsel | Fellow